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1942902879
SHONTAVIA CHARISSA DENNIS
VALDOSTA, GA
NPI
1942902879
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
171W00000X Contractor
Enumeration Date
2023-03-22
Last Update Date
2023-03-22
Business Address
SHONTAVIA CHARISSA DENNIS
1644 FRESNO ST
VALDOSTA, GA 31602-7200
Phone number: 229-262-9093
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Mailing Address
SHONTAVIA CHARISSA DENNIS
1644 FRESNO STREET
VALDOSTA, GA 31602-7200
Phone number: 229-262-9093
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